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ration number CRD42020202094. Additional payment approach has been one of the most important incentives in long-term care (LTC) systems for the past 20 years in Japan. To estimate the effect of additional payments on functional decline in long-term care health facility (LTCHF) residents of Japan. A 24-month retrospective cohort study. Residents aged ≥65years who were newly admitted to LTCHFs in the 2014 fiscal year. National LTC claims data were linked to the survey of institutions and establishments for LTC. Competing ri